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Doctors at NYU Langone’s Perlmutter Cancer Center may use intravesical medications to treat bladder cancer. These liquid medications are placed directly into the bladder through a catheter inserted into the urethra, the tube that runs from the bladder to the outside of the body. The process of inserting the catheter and releasing the medication is called instillation.
Because intravesical medications are placed in the bladder, they don’t circulate throughout the body in the same way that chemotherapy drugs do when they are administered via other methods. This means they have fewer side effects. Intravesical medications exit the body through urination.
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Our doctors may use intravesical medication to treat noninvasive bladder cancer that has not invaded the bladder muscle. They may also use it to prevent recurrences of a rapidly growing, or more aggressive, cancer that has the ability to grow into the bladder muscle or is likely to recur after surgical treatment.
Doctors may give intravesical chemotherapy immediately after transurethral resection to treat any remaining cancer or to help prevent it from returning. Sometimes, intravesical medications—such as those used for immunotherapy, which boosts the immune system—may be used instead of transurethral resection for cancers that are flat and difficult to remove from the bladder wall.
Bacillus Calmette-Guérin is a medication used for immunotherapy that encourages the body’s immune system to attack cancer cells. Perlmutter Cancer Center doctors often use it to manage more aggressive, or rapidly growing, bladder cancer. After instillation, the medication remains in the bladder for up to a couple of hours, and exits the body during urination after the procedure.
When used in conjunction with transurethral resection, treatment with bacillus Calmette-Guerin often begins a few weeks after the resection and is given once a week for six weeks. To prevent the cancer from returning, doctors may prescribe additional bacillus Calmette-Guérin treatments at increasing intervals over the next few years.
Bacillus Calmette-Guérin may cause fatigue, the need to urinate more frequently, pain during urination, and blood in the urine. Our doctors can prescribe medication to help manage these side effects.
Immunotherapy may not be an option for people with compromised immune systems—including those who have received an organ transplant and are taking medications that suppress the immune system, or people who have HIV infection. Doctors may recommend intravesical chemotherapy instead.
At NYU Langone, we offer several innovative therapies, as well as clinical trials, that can be an alternative to intravesical immunotherapy—more than any other medical center in the region. If bacillus Calmette-Guérin is not a treatment option, our doctors may use gemcitabine or a combination of gemcitabine with docetaxel to treat early bladder cancer or aggressive cancer that has not yet invaded the bladder muscle.
Gemcitabine is one of the most common intravesical chemotherapy drugs used to treat bladder cancer. At Perlmutter Cancer Center, gemcitabine may be instilled within 24 hours of transurethral resection to help prevent cancer from returning. After instillation, the medication remains in the bladder for a couple of hours. Doctors may use gemcitabine weekly for a few weeks.
Carcinoma in situ is a form of early bladder cancer that has not spread beyond the point where it originated and into the bladder wall. Valrubicin is another chemotherapy option for people who have carcinoma in situ that has not responded to bacillus Calmette-Guérin or for those who can’t have surgery because of poor health. Valrubicin is usually given once a week for six weeks.
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